血清雌二醇作为体外受精成功的预测指标。
Serum estradiol as a predictor of success of in vitro fertilization.
作者信息
Mittal Suneeta, Gupta Prerna, Malhotra Neena, Singh Neeta
机构信息
Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India.
出版信息
J Obstet Gynaecol India. 2014 Apr;64(2):124-9. doi: 10.1007/s13224-013-0470-7. Epub 2013 Nov 1.
AIM
The aim of this study was to assess the role of total serum estradiol on the day of injection HCG, estradiol per mature follicle, and estradiol per oocytes retrieved (OR) on clinical pregnancy rate (CPR) and oocyte/embryo quality in assisted reproduction.
MATERIALS AND METHODS
A retrospective review of 342 in vitro fertilization cycles with normal ovarian reserve in women who underwent long GnRH agonist protocol was included. The outcomes assessed are number of OR, number of mature oocytes (MO), number of oocytes fertilized (FO), fertilization rate, number of embryos cleaved (EC), cleavage rate (CR), number of Grade I embryos (E), number of cryopreserved embryos (CPE), and CPR. The Estradiol/follicle ratio (E2/fol) was defined as estradiol level per mature follicle >14 mm in diameter. Estradiol/oocyte (E2/O) ratio was defined as estradiol level per OR. These two ratios were categorized by the 25th percentile into four groups.
RESULTS
A positive correlation was seen between E2/fol and OR (r = .334, p value = .0001), MO (r = .335, p value = .0001), FO (r = .222, p value = .002), and CPE (r = .289, p value = .0001). Increased CPR was seen in Group C (E2/fol = 200-299.99) compared to Group A, B, and D (p value = .033). With E2/O ratio, negative correlation was seen between E2/O and OR (r = -.281, p value = .002), MO (r = -.296, p value = .008), FO (r = -.220, p value = .003), EC (r = -.211, p value = .004), Grade 1 embryo (r = -.216, p value = .001), and CPE (r = -.206, p value = .005). No difference in FR, CR, or CPR was seen. No difference was seen in CPR with total serum estradiol.
CONCLUSIONS
In conclusion, serum estradiol is an important determinant of IVF success. While total serum estradiol does not exert any positive or negative influence on IVF outcome, estradiol per mature follicle and retrieved oocytes do have an impact. Pregnancy rate is better when E2/fol is between 200 and 299.99 pg/ml. Also, increasing serum E2/fol positively correlates with better oocytes and embryo quality. In contrast, E2/O negatively correlates with oocytes and embryo quality parameters.
目的
本研究旨在评估注射人绒毛膜促性腺激素（HCG）当天的血清总雌二醇、每个成熟卵泡的雌二醇以及每个回收卵母细胞的雌二醇（OR）对辅助生殖中临床妊娠率（CPR）和卵母细胞/胚胎质量的作用。
材料与方法
回顾性分析342例接受长效促性腺激素释放激素（GnRH）激动剂方案且卵巢储备正常的女性的体外受精周期。评估的结果包括回收卵母细胞数量、成熟卵母细胞数量（MO）、受精卵母细胞数量（FO）、受精率、分裂胚胎数量（EC）、分裂率（CR）、I级胚胎数量（E）、冷冻胚胎数量（CPE）和CPR。雌二醇/卵泡比值（E2/fol）定义为每个直径>14 mm的成熟卵泡的雌二醇水平。雌二醇/卵母细胞（E2/O）比值定义为每个回收卵母细胞的雌二醇水平。这两个比值按第25百分位数分为四组。
结果
E2/fol与OR（r = 0.334，p值 = 0.0001）、MO（r = 0.335，p值 = 0.0001）、FO（r = 0.222，p值 = 0.002）和CPE（r = 0.289，p值 = 0.0001）呈正相关。与A、B和D组相比，C组（E2/fol = 200 - 299.99）的CPR升高（p值 = 0.033）。对于E2/O比值，E2/O与OR（r = -0.281，p值 = 0.002）、MO（r = -0.296，p值 = 0.008）、FO（r = -0.220，p值 = 0.003）、EC（r = -0.211，p值 = 0.004）、I级胚胎（r = - 0.216，p值 = 0.001）和CPE（r = -0.206，p值 = 0.005）呈负相关。在受精率、分裂率或CPR方面未观察到差异。血清总雌二醇对CPR无差异。
结论
总之，血清雌二醇是体外受精成功的重要决定因素。虽然血清总雌二醇对体外受精结果没有任何正面或负面影响，但每个成熟卵泡和回收卵母细胞的雌二醇确实有影响。当E2/fol在2 00至299.99 pg/ml之间时，妊娠率更高。此外，血清E2/fol升高与更好的卵母细胞和胚胎质量呈正相关。相比之下，E2/O与卵母细胞和胚胎质量参数呈负相关。
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